Early Stage Identification and Engagement to Reduce the Duration of Untreated Psychosis: Evaluating the Impact of Screening and Systematic Communication

项目总结/摘要 研究发现，精神病发作和开始专科治疗之间有很大的延迟， 精神病发作（FEP），在美国，未经治疗的精神病（DUP）的持续时间通常超过一年。 需要更好的战略来改善对FEP患者的识别，并迅速让他们参与 协调专科护理（CSC）旨在恢复功能。这项研究将调查美国是否 采用了荷兰的一种成功的检测方法， 向患者和家属传达有关精神病和治疗方案的信息（ComPsych），可以 降低DUP。我们在荷兰的合作者比较了连续寻求帮助的人的筛选， 进入精神卫生服务的人群从精神卫生诊所转诊到临床医生，并发现， 筛查捕获了明显更多的精神病临床高危人群和FEP患者。基于 按照荷兰的模式，在纽约的西奈山卫生系统内，我们已经试点并建立了 对接受精神健康服务的寻求帮助的青少年进行筛查的可行性， 识别FEP病例并快速转诊至专科护理（早期识别和参与， 减少DUP研究（EaSIE），由NIMH R34支持）。进入服务的个人要接受 前驱症状量表-简要版（PQ-B）。筛查呈阳性的人将接受结构化评估， 精神病风险综合征（SIPS）面谈，并转诊至特定阶段的专科护理（FEP或ESTA） 服务）。为了促进服务参与，我们开发、试行并确立了ComPsych的可行性 模型虽然我们的数据显示，与临床医生转诊相比，系统筛查方法（SM）可以 通过在病程早期识别更多的患者， 需要进行研究以评估ComPsych对FEP治疗启动和参与的影响， 进一步降低DUP。我们将使用一个阶梯楔形分组随机对照试验设计， 系统筛选和通信方法（SCM）到SM。在6个月的SM基线期后， 将随机分配12家精神健康诊所（一次2家诊所），在6个月时从SM过渡到SCM 的间隔在这两种情况下，年龄在12-30岁之间的PQ-B筛查阳性的个体将接受SIPS评估 由每个诊所经过培训的临床医生进行检查，并酌情转介到FEP和TFP服务。在SCM条件下， 将使用ComPsych模型来促进启动培训和FEP服务。我们将测量DUP， 符合精神病标准的患者。我们假设：（1）SCM将导致更多的个体 与SM相比，启动ESTA和FEP服务;（2）在SCM条件下，FEP个体的平均DUP将 低于SM条件下FEP个体的平均DUP，因为开始FEP的时间缩短 服务我们还将研究多层次的实施因素，这些因素可以为确定 今后在日常工作中部署供应链管理的实施战略。

PROJECT SUMMARY/ABSTRACT Studies find a substantial delay between the onset of psychosis and the initiation of specialty treatment for first episode psychosis (FEP), with the duration of untreated psychosis (DUP) typically over one year in the U.S. Better strategies are needed to improve identification of individuals with FEP and to rapidly engage them in Coordinated Specialty Care (CSC) aimed at restoring functioning. This study will investigate whether a U.S. adaptation of a successful detection approach from the Netherlands enhanced by an innovative model of communicating information about psychosis and treatment options to patients and families (ComPsych), can reduce DUP. Our collaborators in the Netherlands compared screening of a consecutive help-seeking population entering mental health services to clinician referral from mental health clinics and found that screening captured significantly more individuals at clinical high risk for psychosis (CHR) and with FEP. Based on the Dutch model, within the Mount Sinai Health System in New York, we have piloted and established the feasibility of screening help-seeking youth entering mental health services with the aim of improving early identification of FEP cases and rapid referral to specialty care (Early Stage Identification and Engagement to Reduce DUP study (EaSIE), supported by NIMH R34). Individuals entering services are screened with the Prodromal Questionnaire-Brief Version (PQ-B). Those who screen positive are assessed by Structured Interview for Psychosis Risk Syndromes (SIPS) and referred to stage-specific specialty care (FEP or CHR services). To facilitate service engagement we developed, piloted, and established feasibility of the ComPsych model. While our data showed that compared to clinician referral, systematic screening method (SM) can substantially reduce DUP by identifying a greater number of patients earlier in the course of illness, more research is needed to evaluate the impact of ComPsych on FEP treatment initiation and engagement in order to further reduce DUP. We will use a stepped-wedge cluster randomized controlled trial design to compare a systematic screening and communication method (SCM) to SM. Following a 6-month baseline period of SM, 12 mental health clinics will be randomized (2 clinics at a time) to transition from SM to SCM at 6-month intervals. In both conditions, individuals aged 12-30 who screen positive on PQ-B will be assessed with SIPS by trained clinicians in each clinic and referred to FEP and CHR services as appropriate. In SCM condition the ComPsych model will be used to facilitate initiation of CHR and FEP services. We will measure DUP for patients who meet psychosis criteria. We hypothesize that: (1) SCM will result in a higher number of individuals initiating CHR and FEP services compared to SM; (2) The mean DUP of FEP individuals in SCM condition will be lower than the mean DUP of FEP individuals in SM condition, due to the reduced time to initiate FEP services. We will also examine multi-level implementation factors that can inform the identification of implementation strategies for future deployment of SCM in routine practice.